Good sperm guide

There was a time when infertility was seen as a women’s problem. Not anymore. Older dads are more likely to pass on genetic mutations to their offspring than older mums, according to research. And studies show that male infertility is behind half of all cases where couples fail to conceive after one year. Sperm counts in men worldwide have declined by half over the past 50 years and are continuing to fall. ‘It does seem that sperm counts are falling, but it is hard to say exactly why that is happening,’ says Dr Jane Stewart, a consultant in reproductive medicine at Newcastle Fertility Centre. ‘The studies are conflicting. Lots of environmental factors have been blamed for the fall, including industrial pollutants, but the cause is still a mystery.’ Differences in how male fertility is recorded may also be skewing the results.

The average European sperm count is in the region of 70 million per millilitre. According to the World Health Organisation, a man needs a sperm count of at least 20 million sperm per millilitre of ejaculate to have a chance of conceiving a child without medical intervention.

Sperm, which are the swimming cells that carry a male’s DNA, are continually produced in the testicles at the rate of up to 100 million every day. The process, which is controlled by the endocrine system under the influence of the male sex hormone, testosterone, takes about 60 days. It then takes a further 10 to 14 days for the sperm to pass through the epididymis, which is where they mature, before they can leave the body via ejaculation.

Fortunately, there are plenty of ways that men can optimise the quantity and quality of their sperm.

Age

Men have a biological clock just like women. Studies have shown that men’s fertility starts to decline after the age of 35 and female partners, regardless of their own age, have less chance of getting pregnant. One French study, published in published in the journal Fertility and Sterility in 2005, found that women younger than 30 years old was 25 per cent less likely to conceive a baby if her male partner was 40 years or older. A woman aged 35 to 37 years was 50 per cent less likely to conceive if the male partner was over 40 years old. Studies have shown that the genes contained in the sperm of older men have a greater chance of being abnormal. A study at the University of California, Berkeley found that the sperm of older men were less mobile and less able to move in a straight line.

Allan Pacey, professor of andrology at the University of Sheffield, says: ‘We have known for some time that children of older fathers have a higher risk of being born with a range of genetically linked diseases such as Down’s syndrome, schizophrenia and autism spectrum disorders among others. There is also evidence that as men get older their partner is at increased risk of infertility and miscarriage because of genetic changes which are evident in his sperm.’

WHAT TO DO ABOUT IT

You can’t turn back the clock and the age of first time fathers in the UK is rising steadily to 32 compared to 27 in 1980. However, perhaps it is time for a rethink, according to Dr Pacey who points out that men over the age of 40 are advised against donating sperm. ‘Whilst not wanting to scare the children of older fathers, information like this is important to understand and should remind us that nature designed us to have our children at a young age and if at all possible men and women should not delay parenthood if they are in a position not to.’

Tight underpants

Male models – and footballer David Beckham – may look great in tight designer briefs, but close-fitting underwear is going to hinder your chance of conceiving a child. That’s the conclusion of a large-scale study of 2500 men published in the journal Human Reproduction in June 2012 by researchers at the University of Sheffield and the University of Manchester. Dr Allan Pacey, one of the lead researchers, explains: ‘What we found is that the single biggest lifestyle factor affecting sperm count was tight underwear.’ The reason is probably related to underwear pulling the testicles closer to the body, reducing air circulation and causing the temperature of inside the testes to rise. ‘The scrotum sac hangs outside the body for a reason because testes work at an optimum temperature of around 35 degrees centigrade, or two degrees cooler than body temperature,’says Dr Pacey. Testes that are too hot produce less sperm because the seminferous epithelium, which lines the tubules where cell division takes place, is sensitive to elevated temperatures.

WHAT YOU CAN DO

‘Switch to boxer shorts and trousers which have room over the groin,’ says Dr Pacey. ‘Skinny jeans and tight cycling shorts probably have the same negative effect although we did not investigate this in our study.’

It will take three months to bring fertility levels back to normal. ‘This is how long the body takes to produce a sperm cell from the beginning to the end of the process,’ explains Dr Pacey.

Undescended testicle

This is a common problem that occurs in 3-4 per cent of full term infants but it usually resolves itself before a child is a year old. Occasionally, a male may reach adulthood with the problem still unresolved. Testicles that remain inside the body and have not come down into the scrotal sac will not be producing viable sperm. They are considered abnormal and are also more prone to becoming cancerous.

WHAT TO DO ABOUT IT

If the testes does not descend on its own, surgeons may perform an operation called an orchiopexy to bring the testes down and stitch it in place within the scrotum. ‘Occasionally, this procedure can be carried out on adolescents or adult males and is usually successful,’ says Dr Pacey.

Cancer treatment

‘Men who have undergone cancer treatment may find that their fertility has been affected,’ says Dr Mike Bowen, a consultant gynaecologist based in Oxford. In particular, up to 70 per cent of men who have prostate cancer and have undergone a radical prostatectomy will not be able to maintain an erection after surgery, according to Cancer Research UK. Radiation and chemotherapy treatment for cancer can also impair sperm production. If radiation is focused on or near the pelvic area, abdomen, spine, and/or the whole body, it may reduce sperm count and motility in boys — these conditions may be permanent or may reverse after the treatment if sperm production recovers.

WHAT TO DO ABOUT IT

‘In many cases, specialists may advise patients to freeze sperm for future use,’ says Dr Bowen. ‘\men who have erectile dysfunction may be helped by the drug Viagra.’ Some chemotherapy drugs are more likely to lead to permanent infertility than others. The high-risk drugs most likely to affect reproductive organs are Cytoxan (known generically as cyclophosphamide), Ifosfamide, Procarbazine, Busulfan, and Melphalan. Others, like vincristine and methotrexate, are typically less likely to harm fertility.

Illness

A huge number of illnesses can affect male fertility. Cardiovascular disease, which affects blood circulation, can lead to impotence and failure to maintain an erection. Diabetes, when the body cannot control blood sugar levels and its complications, is another major cause of impotence. A body of research shows that sperm produced by a man with diabetes are more damaged than those from a non-diabetic and less able to fertilise an egg.

Further studies are needed in order to determine why this happens and the extent of the problem.

WHAT TO DO ABOUT IT

Adopting a healthy lifestyle is the primary way to minimise your risk of disease and alleviate symptoms of established health problems. Statins are drugs which can help control the complications of cardiovascular disease and may also have a role to play in disease prevention. Control your diabetes through diet and exercise and medication.

Medications

‘Many different types of medication can affect male fertility through different ways,’ says Dr Jane Stewart. Some, some like the antiobiotic erythromycin are toxic to the testicles and damage cells that produce sperm – sometimes permanently. Others work indirectly, interrupting hormonal signals that stimulate the cells in the testicles which can result in lower sperm counts, like antipsychotic drugs and trycyclic anti-depressants.

Some medications may act to decrease male sexual interest in intercourse, or libido. Other medications may interfere with the ability of a man to get an erection or ejaculate. The antiobiotic tetracycline can block fertilisation.

Calcium channel blockers, which are used to treat high blood pressure, have been shown in some studies to block the ability of the sperm to fertilize an egg.

WHAT TO DO ABOUT IT

‘This is a question of weighing up your options and discussing them with your doctor,’ says consultant gynaecologist Dr Mike Bowen. ‘It may be that the risk of in fertility is outweighed by the benefit of the drug. Or there may be an alternative medication which will not have this affect.’

Variocele

Variocele, which leads to abnormally dilated veins around the testicles, is one of the most common causes of male infertility because it increases the temperature of the scrotum. The testes work most effectively at 35 degrees centigrade – two degrees cooler than the rest of the body. Around 15 per cent of the male population has variocele and 40 per cent of men diagnosed with infertility have this condition. A study by the World Health Organization (WHO) on over 9,000 men showed that varicocele are commonly accompanied by decreased testicular volume and impaired sperm quality. Varicoceles which are untreated cause more damage to the testicles as time goes on.

WHAT YOU CAN DO

Surgery to tie off the damaged veins not only halts decline in testicular function but often reverses it. Around 80 per cent of men who undergo the surgery will have improved quality and quantity of sperm. Recent studies also show that female partners of men who have undergone the operation are more likely to get pregnant.

Blocked ducts

Blocked ducts are an obvious mechanical cause of male infertility. When sperm is almost fully formed, it is stored in two coiled tubes called the epididymides to mature. At the point of ejaculation it moves from the epididymides to the vas deferens where it is expelled from the penis. Infections, particularly chlamydia and gonnorrhea, can lead to blockages of the tubes which carry the sperm from the testes through the penis. A blockage can also be caused by an inherited defect or a groin injury.

WHAT YOU CAN DO

If you play contact sports, wear groin protection. Avoid sexually transmitted infections which can lead to duct blockage. ‘If you suspect you have a sexually transmitted infection, go to see your doctor for advice and early treatment,’ says Mr Mike Bowen.

Exercise

Staying fit and healthy and exercising regularly is important if you want to maximise your chances of conceiving a child. However, men and women who exercise too much can impair their natural fertility. ‘There is evidence that some endurance trained men can affect their reproductive hormone profile, in particular reducing their testosterone levels,’ says Mr Bowen. ‘However, there is no direct evidence that this results in male infertility.’

Cycling is becoming more popular both as a recreation and a means of beating commuter traffic, but too much cycling can lead to impotence, according to Vinod Nargund, a consultant urological surgeon at St Bartholomew’s and Homerton Hospitals London. This is because of prolonged pressure from the saddle on the perineum, which is the area of skin behind the scrotum. This is where nerves and blood vessels enter the penis.

‘Studies on volunteers have shown that cycling in a standing position does not alter penile blood supply after exercise and remain the same as before exercise. Numbness of the genital region is reported by more than 60 per cent of the cyclists. There is a higher incidence of numbness and erectile problems in men who cycle regularly on longer training distances. Penile blood flow is affected due to the compression of vessels by sitting on the saddle.

WHAT YOU CAN DO

Try a softer saddle and stand up to pedal. ‘Studies on volunteers have shown that cycling in a standing position does not alter penile blood supply after exercise and remain the same as before exercise,’ says Mr Nargund. ‘It is important therefore to take rests intermittently during prolonged and vigorous bicycle riding and to restrict the training distance.

Overheating

Anything that raise the temperature of your testicles is going to have a temporary impact on sperm production, even sitting on a crowded commuter train for long periods in a heatwave. Frequent use of hot tubs or saunas may lower your sperm count, according to studies. Spending more than 30 minutes at a time in water heated to 102 degrees Fahrenheit (40 degrees Celsius) or more may lower the sperm count significantly.

WHAT YOU CAN DO

‘Avoid saunas and hot tubs if you are trying to conceive and any other situation where you feel very hot for prolonged periods of time,’ says Mike Bowen.

Know your limits

‘Forget the myth that stored sperm goes stale and needs to be refreshed,’ says Dr Pacey. ‘If you masturbate frequently, you reduce the volume of sperm held in storage and the quantity available when you ejaculate inside your partner.’ Studies have shown that ejaculating more than twice a day can have a negative effect on male fertility.

Every man is different. Although the average ejaculate contains around 40 million sperm, many men have sperm counts far lower, closer to the ‘fertility minimum’ set by the World Health Organisation of 20 million sperm per one millilitre of ejaculate. If they masturbate too often, their sperm count could fall below this. Conversely, it can be as high as 100 million per ejaculate..

WHAT YOU CAN DO

‘If you want to have a maximise your chances of having a baby, you should be having sex with you partner two or three times a week. This is the ideal amount to have maximum number of sperm entering your partner’s bod,’ says Dr Jane Stewart, consultant in reproductive medicine at Newcastle Fertility Centre. Any more than this and the volume of ejaculate will be reduced. And limit masturbation until after conception has occurred. A period of total abstinence of 3-5 days should bring levels up to their maximum, according to Dr Pacey.

Having too little sex

One of the leading causes of failing to conceive a child is actually lack of sexual relations. And stress plays a major role in turning people off the idea. Stress reduces male fertility in two ways. Firstly, stress hormones like cortisol seem to have an effect on the way that men ejaculate, according to research. High cortisol levels have a dampening effect on testosterone, which in turn lowers the quantity and quality of sperm. If stress is chronic, this can become a long-term problem.

‘Stress also has an important negative effect on libido and the desire to have sex in the first place,’ says Dr Jane Stewart. ‘Men who are stressed may not be able to get an erection at all because of physiological effects of lower levels of testosterone circulating in the body and the psychological effects which are critical to creating desire in the first place.’ In fact, 15 per cent of men experience decreased libido because of stress, while 5 per cent of men experience impotence because of it.

WHAT YOU CAN DO

If stress is reduced, either by taking up meditation or improving work/life balance, the effect on fertility should be reversed almost immediately. Failure to conceive can be an important cause of stress which is why it helps to be relaxed and not too focus on the goal of having a child.

Too little sunshine

Vitamin D – the sunshine vitamin – is essential to sperm health. In 2006, it was found that human sperm had multiple Vitamin D receptors on its head and nucleus, suggesting that the cell needs this vitamin to function. Getting enough UV rays is key to the health of male sperm, according to research presented to the Fertility Society of Australia conference in 2008. Laura Thomson, a doctoral student from University of Sydney found that vitamin D deficiency – caused by too little sun exposure – played a a significant role in determining male fertility.

Thomson’s study involved screening 794 men who attended the same fertility clinic in Sydney in Australia. Nearly a third, which is similar to the average, were found to suffer from too little Vitamin D which is synthesised in the skin during exposure to sunlight. A group of 123 of the vitamin D deficient men in the Australian study were followed for 3 months as they took vitamin D containing multivitamin supplements, antioxidants and lost weight. Follow-up tests showed improvements in sperm shape and a 75 per cent drop in sperm DNA fragmentation, when the DNA is damaged. In a quarter of these men, pregnancy was successful.

WHAT YOU CAN DO

Go easy on sunscreen when you are out and about not in the heat of the day, between 11am and 3pm. Just rolling up your sleeves in your lunch break while outdoors should be enough to help your skin create enough Vitamin D from sunshine. The effects on fertility should be felt within three months.

Heavy alcohol intake

Alcohol is a toxin that kills the cells that generate sperm. Too much alcohol can reduce sperm count and change the shape of sperm cells, making them less effective at fertilising an egg. The effects won’t be noticeable unless you drink more than eight units in a day, according to studies.

Most alcoholics have a very low sex drive because excessive alcohol over a long period of time raises levels of female hormone oestrogen in the male body.

WHAT CAN YOU DO

Abstain from alcohol or significantly reduce your intake three months before you try to conceive a child. Heavy drinking can damage DNA in all sperm cells held in the testes so it would take three months of reduced drinking to create sperm from scratch. Impotence caused by alcoholism can take longer to reverse or may not be fully reversible.

Smoking

‘In terms of how many sperm you produce in the testes, smoking does not seem to have an effect,’ says Dr Pacey. ‘However, smoking does damage DNA within the sperm cells, which could lead to infertility and miscarriage, which is the female body’s way of getting rid of a developing embryo with major genetic abnormalities.

A UK study, published in the medical journal Human Reproduction, recruited 2,249 men from 14 fertility clinics around the UK2 and asked them to fill out detailed questionnaires about their lifestyle. Dr Andrew Povey, from the University of Manchester’s School of Community Based Medicine, said: ‘Despite lifestyle choices being important for other aspects of our health, our results suggest that many lifestyle choices probably have little influence on how many swimming sperm they ejaculate. For example, whether the man was a current smoker or not was of little importance. The proportion of men who had low numbers of swimming sperm was similar whether they had never been a smoker or a smoker who was currently smoking more than 20 cigarettes a day.’

WHAT CAN YOU DO

Current NICE guidelines remain that men who want to conceive should give up smoking. However, If you want to have a child, give up smoking at least three months before trying to conceive with your partner. Avoid all recreational drugs.

Obesity

Studies have found links between obesity and fertility problems in both men and women. In one study, men with a higher body mass index (BMI) had a significantly higher risk of being infertile compared with men considered to be normal weight. In fact, the study found that men who are of normal weight and then put on just 20 lbs could increase their chance of male infertility by 10 per cent.

‘Several mechanisms may account for the effect of obesity on make infertility, including changes in hormone levels caused by increased weight and increased scotal temperatures due to the fact that larger men tend to have hotter groins with fat acting as insulation,’ says Mr Bowen.

Men who develop ‘man boobs’ may be more at risk because the condition suggests heightened levels of the female hormone oestrogen. There is no hard evidence that men who have beer bellies are more at risk than those who are bigger all over.

A separate study found that men who had a higher BMI were more likely to have poor quality ‘fragmented’ sperm where the DNA parcel has broken into pieces. Fragmented sperm DNA is linked to reduced fertility as well as an increased risk of miscarriage. Babies born are more likely to suffer from inherited conditions such as Down’s Syndrome.

WHAT CAN YOU DO

Healthy gradual weight loss should take months and possibly even years to achieve, depending on how much you need to drop to reach a healthy BMI. ‘However, neither reversibility of obesity-associated fertility with weight loss not effective therapeutic interventions have been studied in depth,’ says Mr Bowen.

Laptop on your lap

‘This is all to do with heat generated by the lap top sitting right over the genital region,’ explains Dr Suzanne Kavic, a reproductive endocrinologist based in Pittsburgh in the US. ‘However, the heat generated from laptops can impact sperm production and development ‘The heat generated from laptops can impact sperm production and development making it difficult to conceive down the road,’ Dr Kavic advises men not to place their laptops on their laps at all since any significant heating of the tesicles could result in lower sperm counts and poorer sperm quality.

WHAT CAN YOU DO

Prop your lap top on the table. In most cases, the effects should be reversed within three months or a full cycle of sperm generation.

Poor diet

There is some evidence that men who eat a diet rich in antioxidants, which mop up damaging free radicals, are more fertile than men who don’t. [Source: Eskenazi et al., 2005 Human Reproduction volume 20] Colourful vegetables include carrots, purple cabbage, leafy greens are rich in antioxidants like Vitamin E and Vitamin C. Fruit including oranges, lemons and bluecurrants are also a rich sources of Vitamin C.

Researchers at the Harvard Medical School have found that diets high in saturated fat may negatively affect the quality, as well as the quantity of sperm. They also found that increasing dietary intake of omega-3 fatty acids, a polyunsaturated fat, could improve male reproductive health.

WHAT CAN YOU DO

Eat plenty of oily fish and cut down on red meat. A new study has also pinpointed walnuts as an excellent source of good fatty acids. Eating around two handfuls of walnuts a day improves sperm health in young men, a study in the journal Biology of Reproduction suggests.

Sperm shape, movement and vitality improved in men who added walnuts to their diet over 12 weeks.

Bodybuilding

The trend for bulking up with the help of anabolic steroids is having a worrying effect on men’s fertility up and down the country. ‘In the North East, we are certainly noticing an increase in the number of men who do use steroids and come to us with fertility problems,’ says Dr Jane Stewart. High protein shakes should not cause the problems but there is increasing concern that they may contain ingredients which are not on the ingredients lists.

Steroids, which mimic the male hormone testosterone, cause an increase in muscle mass but they also trick the body into thinking that the testes, which produce natural testosterone, are producing too much. ‘Production of sperm can shut down completely,’ says Dr Stewart. ‘Men may notice that their testes are shrinking.’

WHAT CAN YOU DO

‘Sadly, infertility caused by use of steroid drugs is not always reversible,’ explains Dr Stewart. However, most men who stop taking steroids will see a gradual return to normal over several months or years. Build muscle naturally with exercise and weight training.

Occupation

Some jobs are riskier than others when it comes to male infertility. Studies have shown that men who work regularly with lead – roofers and metal smelters – have lower sperm counts and IVF couples who have even small traces of lead in their bloodstream are less likely to conceive than those who don’t. ‘We know that lead is a testicular toxin and lowers production of motile sperm,’ says Dr Pacey. Painters and printers who are exposed to the chemical glycol ether are also more at risk. This chemical is found in glues and printing inks.

Occupations which involve working in high temperatures like metal smelting have also been linked to male infertility.

WHAT CAN YOU DO

It may not be possible to avoid the contaminants altogether but men can take precautions such as wearing face masks when dealing with known chemicals and ensuring that products don’t come into direct contact with the skin. ‘No one knows for sure but I would predict at least three months, so that new sperm are not affected. The problem with lead is that it tends to stay in the body for a long time, so this effect could take years to remove completely,’ says Dr Pacey.

Gum disease

Visit a dental hygienist regularly if you want to maximise your chances of conceiving a child, according to research. Bacteria in gums, which easily passes through the mouth into the bloodstream, may have an inflammatory effect on other parts of the body including the testes which produce sperm. Scientists in Isreal pinpointed gum disease as one of the causes of male infertility, after seeing an increased rate of gum disease among men having trouble with conceiving a child.

The Israeli study looked at the sperm quality of 56 men who came into a fertility clinic. They found that 80 per cent of the men suffered from either gum disease and a low sperm count or zero sperm count was found in 68 per cent of the men.

WHAT CAN YOU DO

Visit a dental hygienist regularly if you want to maximise your chances of conceiving a child, according to research. The infertility dip can be reversed in a few days after gum disease is eradicated because this is how long it takes any inflammation to subside.

Going veggie

Soya protein, which is a primary source of protein for vegetarians, is a rich source of phyto-oestrogens, or plant oestrogens. Men who drink a lot of soya milk or eat a lot of soya products may inadvertently be raising their levels of female hormones which inhibits sperm production, according to a study carried out by researchers at Queen’s University, Belfast. The director of reproductive medicine at Queen’s University, Belfast, Dr Sheena Lewis, said: ‘What we have shown is that if men are consuming large amounts of soya products, for example, there is a negative relationship between that and the quality of their sperm.

WHAT YOU CAN DO

Read the labels on food products. ‘If they already have a slight problem in that area, then it might be better for them not to consume so much,’ says Dr Lewis who points out that ‘hidden’ soya protein is often found in fast food and ready meals where it is used to supplement more expensive meat protein.

‘You would have to eat a lot to feel the effect,’ says Dr Jane Stewart.

Mobile phones

Some scientists believe that electromagnetic field exposure from mobile phones may have a negative effect on sperm production. A study published in 2009 found that sperm in a test tube become less active when they are exposed to an electromagnetic field and the DNA within sperm is more likely to break down.

Dr Pacey says that the jury is still out and there is no hard evidence that mobile phone emissions have any effect on male fertility.

WHAT YOU CAN DO

‘It is speculative for now but if you want to play it safe, you should probably keep your mobile phone in your jacket pocket rather than in your jeans,’ says Dr Stewart.

And before you were even born…

Many factors determine a boy’s future fertility before he is even born. Pregnant women who take common painkillers like paracetamol and ibuprofen could quadruple the risk of their sons suffering fertility problems, according to a study published in the journal Human Reproduction. This is despite the fact that current guidelines issued by the Department of Health say women are able to take mild analgesics such as paracetamol and ibuprofen without any danger to their unborn children.

Exposure to some industrial chemicals in utero may also damage the developing testes which make sperm. Bisphenol-A, which is found in many plastic packaging and bottles is known as the ‘gender bending’ chemical for its ability to interfere with the male reproductive system in animals. Worryingly, women who are exposed to toxic envrionmental compounds before they even get pregnant could pass on infertility to their future child, according to a study by researchers at Mount Sinai Hospital’s Samuel Lunenfeld Research Institute in Toronto, Canada.

Thea Jourdan is the founder and editorial director of Hippocratic Post as well as being Editor of Apothecary, the journal of the Worshipful Society of the Apothecaries of London, and a contributor to the Good Health section of the Daily Mail. She sits on the executive committee of the Medical Journalists’ Association.

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